Cholangiocarcinoma (bile-duct cancer) is anatomically classified into intra-hepatic, peri-hilar and distal types. Early findings are usually non-specific; symptoms depend on where the tumour grows and how quickly it obstructs bile flow.
- Painless jaundice
Yellow discoloration of skin and sclera plus dark urine and clay-coloured stools is the hallmark of peri-hilar or distal tumours that occlude the main bile ducts . - Generalised pruritus
Deposition of bile salts in the dermis produces intense, often intractable itching that may precede visible jaundice. - Right-upper-quadrant pain
A dull, non-colicky ache or sense of fullness develops as the mass enlarges or as the gall-bladder and liver capsule become stretched. - Systemic features
Fatigue, anorexia, low-grade fever and night sweats are common, while unexplained weight loss reflects tumour cachexia and reduced oral intake . - Acute cholangitis picture
Fluctuating fever with rigors, hypotension and confusion may occur if malignant obstruction becomes super-infected. - Intra-hepatic variant
Tumours within the liver parenchyma seldom obstruct major ducts early; they present with vague upper-abdominal discomfort, fatigue and weight loss, with jaundice appearing only late if at all .
Because early symptoms overlap with benign biliary disease, any new combination of jaundice, pruritus and weight loss—especially in patients over 50 or those with primary sclerosing cholangitis—should prompt urgent imaging and laboratory work-up.
| Symptom | Typical Presentation |
|---|---|
| Painless jaundice | Yellow skin/sclera, dark urine, pale stools |
| Pruritus | Intense, may precede jaundice |
| RUQ pain/Fullness | Dull, non-colicky ache |
| Weight loss & fatigue | Rapid, unintended |
| Fever & night sweats | Low-grade, intermittent |
| Acute cholangitis | Rigors, hypotension, mental change |